=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720779341
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE ANNA SCARLETT STODDARD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2023
-----------------------------------------------------
Last Update Date | 05/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2240 N OPDYKE RD
-----------------------------------------------------
City | AUBURN HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48326-2435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-289-7400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37767 VIA ROSALIE ST
-----------------------------------------------------
City | CLINTON TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48036-2972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-238-6909
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F03230308
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------